Provider Demographics
NPI:1700908241
Name:SMITH, EDDIE M (MD)
Entity Type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:GOLDEN MEADOW
Mailing Address - State:LA
Mailing Address - Zip Code:70357-0457
Mailing Address - Country:US
Mailing Address - Phone:985-325-6226
Mailing Address - Fax:985-325-6242
Practice Address - Street 1:103 PICCIOLA PKWY
Practice Address - Street 2:
Practice Address - City:CUT OFF
Practice Address - State:LA
Practice Address - Zip Code:70345-3572
Practice Address - Country:US
Practice Address - Phone:985-325-6226
Practice Address - Fax:982-325-6242
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA18307208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1357464Medicaid
LAB63877Medicare UPIN
LAB63877Medicare UPIN